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More employers are offering financial incentives to get workers into wellness programs, fitness classes or gyms and demanding to see improvement before they reward the workers with cash. (Photo credit: Wikipedia)

Though most U.S. employers regularly greet their workers with a bigger and bigger tab for health care, they are also offering perks and cash incentives to stay healthy.

Almost 60 percent of large employers are using incentives as a way to get them into a gym, wellness program or other health improvement program, according to a new study by Aon Hewitt, (AON) the large global human resource consultancy. That compares to just 37 percent in 2011.

At least four in five U.S. employers – 84 percent – now provide incentives to fill out a health risk assessment, usually an online questionnaire about their health status, Aon Hewitt said. Another two-thirds of U.S. workers are offering biometric screenings such as tests for cholesterol and glucose levels.

Most employers’ incentives are the equivalent of $50 to $150 that can include reduction of the premium cost that is deducted from a worker’s paycheck. It’s also becoming more common for employers to offer gift cards of $50 or $100 or additional paid days off, Aon Hewitt said.

The survey comes from a database of nearly 2,000 employers with 20 million employees and their dependents. Benefits are provided by large and medium-sized employers and administered by an array of health plans like UnitedHealth Group, (UNH) Humana Inc. (HUM), Aetna (AET) and Blue Cross and Blue Shield plans.

Call it a larger carrot in the carrot and stick approach to health care which has long had more stick in the form of higher health care costs deductibles and co-payments when Americans use more and more health care services that lead to higher costs for everybody.

The incentives are used in hopes that workers will adopt a healthier lifestyle, lose weight and help workers stay out of the hospital and save the employer money on their growing tab for health care.

The incentives are also increasingly being tied to the need for workers to act. Of the employers that are offering incentives, for example, nearly 60 percent are providing the incentive if employees modify their lifestyles by quitting smoking or losing a certain amount of weight.

“Incentives solely tied to participation tend to become entitlement programs, with employees expecting to be rewarded without any sense of accountability for better health,” said Jim Winkler, chief innovation officer for Health & Benefits at Aon Hewitt. “To truly impact employee behavior change, more and more organizations realize they need to closely tie rewards to outcomes and better results rather than just enrollment.”